This article reviews the evaluation and treatment of patients with anal fistulas in the new millenium. New methods of evaluation with transanal ultrasonogra-phy with hydrogen peroxide enhancement or magnetic resonance imaging can assist surgeons in treatment planning. New surgical treatments, such as fibrin glue, are sphincter saving and associated with significantly lower rates of fecal incontinence. Sphincter-saving operations have higher recurrence rates but significantly lower rates of fecal incontinence compared with sphincter-sacrificing operations such as fistulotomy. Because of the morbidity of sphincter-sacrificing operations, sphincter-saving techniques are the preferred initial approach for nearly all patients with anal fistulas.
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